Exercise training to better Canadian hospitals

A decade after the 9-11 terrorist attacks and, closer to home, five years since the Dawson College shooting in Montreal that left two dead and 19 injured, the question still remains: Are Canada’s hospitals prepared for a mass-casualty incident? According to Schulich School of Medicine & Dentistry professor Vivian McAlister, a surgeon with the Canadian Forces, you may not like the answer.

While field exercises are frequently held by first responders such as fire departments, emergency services and police, these drills usually stop at the hospital door. A survey by Dr. Avery Nathens of St. Michael’s Hospitals in Toronto found most hospitals in Canada to be poorly prepared for mass casualty incidents.

“Most of our hospitals hope sudden disasters won’t happen in their area,” says McAlister, who is directing a one-day mass-casualty training exercise being held today as part of the Canadian Surgery Forum at the London Convention Centre. “Emergency preparedness plans have focused on what to do should there be an infectious disease outbreak. Hospitals in Ontario have had to deal with SARS and H1N1; they have rarely had to deal with mass-casualty incidents.”

If one occurs, everyone pulls together and does their best, McAlister adds, but even after an incident “we don’t prepare, probably on the basis that lightening doesn’t strike the same place twice.

“The biggest difference between preparing for SARS and for a mass-casualty incident is that casualties need rapid surgery,” he says. “Emergency preparedness plans in Canadian hospitals have mainly involved administrators. Now, they will have to include surgeons and emergency physicians.”

The mass-casualty training exercise, part of what will be the biggest event in surgery in Canada this year, will use simulation and scenario role play, presentations and interactive discussions to cover emergency preparedness. It will review material often presented in three-day courses in Europe and the United States, along with training techniques developed by the Canadian Forces.
McAlister says the objectives of the training are to better ensure hospitals can cope with multiple- or mass-casualty situations and, down the road, prepare and direct rehearsal exercises on their own.

Along with McAlister, the exercise will include participation from:

Dr. Tarek Razek, Chief of Trauma at McGill in Montreal, who led the team that dealt with the Dawson College shootings;

Dr. Paul Charlebois, a Canadian Forces intensive care physician based in Halifax, N.S., who will lecture on triage, the method used first in the military and increasingly in civilian disasters to prioritize care for trauma victims;

Dr. Morad Hameed, director of the UBC General Surgery Residency Program, who will suggest ways hospitals can generate surge capacity in the few minutes they have between notification of a disaster and arrival of the casualties;

Dr. Neil Parry, a trauma surgeon in London, who will discuss ways to avoid mixing up patients during the chaos of an emergency and describe new blood transfusion protocols; and

Dr. Brian Church, a Canadian Forces anesthetist, will demonstrate techniques used by the Canadian Forces to prevent the frantic pace in the emergency department during a disaster from becoming chaotic.

“It is fortuitous that the first disaster preparedness course should be held in London this year,” says McAlister. It was 100 years ago, in 1911, when the city hosted the first field exercise by the Canadian Army Medical Corps when protocols were developed to deal with casualties during the First World War.

“In 1911, military doctors in Canada thought they were unprepared for the mass-casualty management that is needed in war,” he says. “Over a three-week period, they developed and practiced the protocols that were used three years later to treat huge numbers of casualties.”

McAlister says 100 years later, the Canadian Forces Health Service team in Afghanistan successfully managed more mass-casualty incidents than we will see in Canada in a lifetime.

“This was possible because the Canadian Forces still continue the tradition, started in London, of rehearsal training with simulation exercises,” he says.